Minutes - November 10, 2022 - Board of Health Meeting

Members Present: 

Mr. Matt Reid (Chair)
Ms. Kelly Elliott (Vice-Chair)
Mr. John Brennan (arrived 8:44 p.m.)
Mr. Selomon Menghsha (attended virtually)
Ms. Maureen Cassidy
Ms. Aina DeViet
Mr. Michael Steele
Ms. Mariam Hamou

Regrets:

Ms. Tino Kasi

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer
Ms. Maureen MacCormick, Director, Healthy Living
Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease
Ms. Jennifer Proulx, Acting Director, Healthy Start
Ms. Sarah Maaten, Acting Director, Office of the Medical Officer of Health
Mr. David Jansseune, Assistant Director, Finance
Ms. Cynthia Bos, Manager, Human Resources
Ms. Kendra Ramer, Manager, Privacy, Risk and Project Management
Mr. David Pavletic, Manager, Food Safety and Healthy Environments
Mr. Dan Flaherty, Manager, Communications
Mr. Alex Tyml, Online Communications Coordinator
Mr. Mike Kadour, Consultant
Mr. Steven Villani, Medical Student

Chair Matt Reid called the meeting to order at 7:00 p.m.

Disclosure of Conflict of Interest

Chair Reid inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

Ms. Emily Williams, Chief Executive Officer requested Report No. 68-22 “Laptop Purchase – Contract Award” be added to the agenda.

It was moved by Ms. Maureen Cassidy, seconded by Ms. Mariam Hamou, that the AGENDA for the November 10, 2022 Board of Health meeting be approved, as amended.
Carried

Approval of Minutes

It was moved by Ms. Aina DeViet, seconded by Ms. Cassidy, that the Board of Health approve the MINUTES of the October 20, 2022 Board of Health meeting.
Carried

It was moved by Mr. Michael Steele, seconded by Ms. Kelly Elliott, that the Board of Health receive the MINUTES of the November 3, 2022 Finance and Facilities Committee meeting.
Carried

Chair Reid called upon Dr. Alexander Summers, Medical Officer of Health who introduced Ms. Sarah Maaten as the Acting Director, Office of the Medical Officer of Health.

Reports and Agenda Items

Recognition of Departing Board of Health Members (Verbal)

Chair Reid introduced verbal report re: “Recognition of Departing Board of Health Members” and offered comments of recognition and thanks to three departing Board of Health members, for whom this would be their last meeting on the Board of Health: Ms. Cassidy, Ms. Elliott, and Ms. Hamou.

It was moved by Mr. Steele, seconded by Ms. DeViet, that the Board of Health receive the Verbal report re: “Recognition of Departing Board of Health Members” for information.

Carried

Governance Committee Meeting – November 10, 2022 (Verbal Update)

This report was introduced by Ms. DeViet, Chair, Governance Committee. Ms. DeViet indicated that two reports had been presented at the November 10, 2022 Governance Committee meeting, Report No. 14-22GC “2021-22 Provisional Plan Update” and Report No. 14-22GC “MLHU Q3 2022 Risk Register”.

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health:

1. Receive Report No. 13-22GC, re: “2021-22 Provisional Plan Update” for information; and,
2. Approve the extension of the 2021-22 Provisional Plan to the end of 2024 following a current state analysis with a plan to develop a 2025-2029 Strategic Plan in 2024.

Carried

It was moved by Ms. DeViet, seconded by Mr. Selomon Menghsha, that the Board of Health:

1. Receive Report No. 14-22GC, re: “MLHU Q3 2022 Risk Register” for information; and,
2. Approve the Q3 2022 Risk Register (Appendix A).

Carried

It was moved by Ms. Elliott, seconded by Ms. Cassidy, that the Board of Health receive the verbal report, re: “Governance Committee Meeting – November 10, 2022” for information.
Carried

Food Safety Program Update (Emerging Trends) (Report No. 64-22)
This report was introduced by Ms. Mary Lou Albanese, Director, Environmental Health and Infectious Disease who introduced Mr. David Pavletic, Manager, Food Safety and Healthy Environments.

Highlights of this report include:

• Public Health Inspectors (PHIs) with the Middlesex-London Health Unit are observing emerging trends in food businesses including shared kitchens/ghost kitchens, home-based food businesses, increased special events and pop-up markets, and urban farming operations. It is assumed these trends are due to the pandemic and the rise of delivery services as a result of pandemic restrictions.
• Ghost kitchens are not new but are rising in popularity. They occur when a food business that predominantly markets its product online and through delivery services, rents kitchen space from another food business. PHIs do not have a solid understanding of the number of ghost kitchens currently in operation as many do not know they are required to inform the Health Unit they are in operation. PHIs become aware of a ghost kitchen operation during inspections or interactions with the business owning the kitchen. Education in the community is required to raise awareness of the requirements for these businesses.
• During the pandemic, the Province changed legislation to allow for low-risk food to be prepared at home for sale to encourage new businesses. While it is allowed in Middlesex County, currently these operations are banned in London by local zoning restrictions. In response, the City of London is considering changes to its bylaw. If implemented, there would be an increase in home-based food operations which would require risk assessments and inspections from PHIs.
• The number of special events have increased from pre-pandemic levels, especially for small to medium sized events. These require more capacity for inspections.
• PHIs are seeing more microgreens and vertical farming operations in urban areas due to the popularity of these products. The Health Unit has consulted with OMAFRA on these operations.

Ms. Hamou inquired if people rent food trucks similar to the ghost kitchens. Mr. Pavletic indicated that he is not overly familiar with mobile vendors sharing their kitchens, but they would be addressed the same as ghost kitchens and would also require notifying the Health Unit they are operating so a PHI can consult with them.

Ms. DeViet inquired if the onus is on the owner of the kitchen to notify the Health Unit that another business is using its kitchen, or on the business renting the kitchen. She also asked how the Food Safety and Health Environments Team becomes aware of ghost kitchens and how businesses become aware of their responsibilities to notify the Health Unit. Mr. Pavletic indicated that the onus is on the business renting the kitchen because, like anyone who opens a business, they would need to know applicable regulations. Once the Health Unit is notified of a new business, a consultation and inspection are arranged. New operators may not know they need to notify the Health Unit because they believe the kitchen they are using is already inspected and that is sufficient. PHIs have become aware that a kitchen is rented out during their inspection of the kitchen with the owner.

Ms. Elliott inquired what the respective roles of the Health Unit and of OMAFRA are with regards to urban farming operations. Mr. Pavletic indicated that operations like vertical farming and microgreens are opening in facilities already inspected by the Health Unit. Agencies like OMAFRA take a risk-based approach in their inspections and as these urban farming operations are at a much smaller scale than traditional farms and lower risk, they would not be inspected by OMAFRA. The Health Unit has reached out to OMAFRA and coordinated some of their members providing education and resources to MLHU PHIs to guide inspections.

It was moved by Ms. Elliott, seconded by Ms. Hamou, that the Board of Health receive Report No. 64-22, re: “Food Safety Program Update (Emerging Trends),” for information.
Carried

Current Public Health Issues (Verbal Update)

Dr. Summers shared a PowerPoint presentation and provided this report. Highlights include:
Respiratory Illnesses

• Ontario is experiencing a convergence of COVID-19, influenza, and RSV.
• Percent positivity of influenza has increased significantly in the past couple of weeks provincially and locally.
• COVID-19 activity is more stable than influenza but is increasing in percent positivity.
• MLHU has adjusted its data dashboard to present information on both COVID-19 and influenza.
• COVID-19 vaccination rates for booster doses received in the past 6 months is increasing gradually.
• Locally, paediatric ICU capacity has not been exceeded due to paediatric COVID-19, influenza, and RSV; however, ICU capacity is being exceeded in other regions.
• Recommendations for addressing the high rates of respiratory illnesses are familiar: vaccinations, masking in crowded areas, staying home when sick, and hand hygiene.

Health and Homelessness

• Continue to experience significant pressure of homelessness locally, which is also experienced in many communities in Southwestern Ontario. Homelessness has likely doubled in the past year.
• MLHU participated in organizing a Health and Homelessness Community Summit. The first meeting was held the previous day. There was success in trying to find common understanding, but more work remains to be done. MLHU is providing a public health perspective on homelessness and community leadership on bringing partners together.

Syphilis and STIs

• Syphilis and STIs are an ongoing concern, particularly bacterial STIs. Prior to the pandemic, syphilis was emerging as a public health concern after nearly two decades. Rates of syphilis are increasing as pandemic restrictions lift.
• Recently, MLHU has received its first reports of congenital syphilis.
• MLHU will be monitoring the situation closely and determining what can be done at a population level.

Monkeypox

• The local Monkeypox outbreak has been declared over.
• There was tremendous community leadership and effective communication campaigns in collaboration with the Gay Men’s Sexual Health Alliance and other local organizations.
• Middlesex-London had the third highest per capital vaccine administration in the province.

Chair Reid in quired which vaccinations were being recommended to children in response to respiratory illnesses. Dr. Summers indicated that the COVID-19 and influenza vaccines were recommended for all children above the age of 6 months. There is no vaccine for RSV. For high-risk infants there is a long-standing program which provides immunoglobulins to passively deliver antibodies.

Ms. DeViet inquired about the demographics on the uptake of COVID-19 and influenza vaccinations. Dr. Summers indicated that the trend is upwards but slow in children for uptake of the COVID-19 vaccine. It is challenging to speak to the uptake of the influenza vaccine because it is not tracked as it is administered. All the Health Unit can speak to is the quantity of influenza vaccine MLHU has distributed to providers.

Ms. Hamou commented that there is speculation on social media that the Minister of Health might provide a COVID-19 update on Monday and inquired if Dr. Summers had any insights. Dr. Summers responded that he anticipates that messaging from the province will likely be in response to the ongoing paediatric hospital capacity concerns, but he does not know for sure what, if any, announcements might be.

Ms. Hamou inquired if the Health Unit has any role in addressing the current shortages of paediatric medications like Advil and Tylenol. Dr. Summers indicated that this issue is outside the purview of the Health Unit and that the Health Unit would advise parents to speak to their primary care providers.

Ms. Hamou inquired if the Health Unit had any demographic information for the cases of STIs. Dr. Summers indicated the Health Unit will be conducting a more comprehensive epidemiological analysis in the coming weeks. Prior to the pandemic, the growth in syphilis infections was occurring in men; however, it is now impacting all genders and age demographics are expanding as well. The good news is HIV rates relative to 2017 have come under control with the goal to decrease them further.

It was moved by Ms. DeViet, seconded by Mr. Steele, that the Board of Health receive the Verbal update re: “Current Public Health Issues” for information.
Carried

Medical Officer of Health Activity Report for October (Report No. 65-22)

It was moved by Ms. Cassidy, seconded by Ms. Elliott, that the Board of Health receive Report No. 65-22, re: “Medical Officer of Health Activity Report for October,” for information.
Carried

Chief Executive Officer Activity Report for October (Report No. 66-22)

It was moved by Mr. Steele, seconded by Ms. Hamou, that the Board of Health receive Report No. 66-22, re: “Chief Executive Officer Activity Report for October,” for information.
Carried

Finance & Facilities Committee Meeting – November 3, 2022 (Report No. 67-22)

This report was introduced by Mr. Steele, Chair of the Finance and Facilities Committee. Three reports were discussed during the November 3, 2022 Finance and Facilities Committee meeting. Mr. Steele introduced Mr. David Jansseune, Assistant Director, Finance to speak to Report No. 18-22FFC re: 2022 Q3 Financial Update and Factual Certificate. Mr. Jansseune shared a PowerPoint presentation.

Highlights of this report included:

• 100% funded programs include the nurse retention incentive, CLIF, School Focused Nurses Initiative, Seniors Dental Care Capital – Strathroy, and COVID-19.
• Nurses Retention Incentive: Eligible nurses to be paid up to $5000 in two installments. MLHU has paid just over $1 million with the amounts still to be finalized.
• CLIF: Funding is $416,000 with spending as of September being $252,000 and forecasted spending being $304,000.
• School Focused Nurses Initiative: Funding is $1,643,000 with forecasted expenses of approximately $350,000, resulting in expected clawbacks from the Province in December, 2022. The program has experienced ongoing difficulties recruiting into the positions and meetings are planned with managers and directors to discuss how better to use the funding.
• Seniors Dental Care Capital – Strathroy: Funding is $1,050,000 with no expenses to date, but a lease has been signed and an request for proposals for a construction bid was released the previous Friday.
• COVID-19 numbers were discussed with Q3 Variance Analysis
• Q3 Variance Analysis – Consolidated
• Shared funding programs consist of mostly mandatory programs. As of Q3 they were $2.5 million favourable to budget. Salaries and benefits have been favourable to budget due to vacancies, but unfavourable to budgeted overtime with overtime required to address COVID-19 and recovery efforts. General Expenses were favourable with reduced spending across all areas.
• COVID-19 programs were $5.6 million unfavourable to budget due to the misalignment in the timing of receiving funding and expenses. COVID-19 clinics continue to spend to budget whereas case and contact management is spending approximately 60% of its budget. Overtime was split between clinics and case and contact management; however, overtime was not budgeted for case and contact management, contributing to a $1,006,000 unfavourable variance.
• Overall, Q3 consolidated numbers were $3.1 million unfavourable to budget.
• Forecasting salaries was conducted for: Shared Funding Programs using estimated department vacancy rates and known changes to staffing; COVID-19 using trends; and General Expenses using expected annual spend.
• Forecasted numbers include:
• Shared Funding Programs forecasting a surplus of $2.3 million
• COVID-19 is forecasting expenditures of $22.2 million. The province has directed that any surplus in mandatory programs is to be directed towards COVID-19 expenses and will be using Q3 forecasting to determine if the province will provide any additional funding. As Shared Funding Programs are forecasting a surplus of $2.3 million, this amount is subtracted from the forecasted COVID-19 expenditures, resulting in an anticipated funding amount of $19.9 million. To date, MLHU has received $10.2 million, leaving $9.7 million to be received.
• Nurses Retention Incentive will be treated as a flow-through.
• Cashflow is forecasted to be positive, dependent on reconciliations.
• The bank loan for the upfitting of the CitiPlaza offices is for 20 years with $260,000 annual payment. The fixed amount is $3,050,000 with $2,838,000 owing and the variable amount is $1,150,000 with $1,049,000 owing.

It was moved by Mr. Steele, seconded by Ms. Hamou, that the Board of Health receive Report No. 18-22FFC, re: “2022 Q3 Financial Update and Factual Certificate” for information.
Carried

Chair Steele introduced the next report, Report No. 19-22FFC, re: Proposed Adjustments to Reserves and called upon Mr. Jansseune to share some comments.

Highlights of this report include:

• The Health Unit is requesting approval to contribute $250,000 to the Technology and Infrastructure Reserve using 2022 surplus municipal funds. This transfer to reserve was not budgeted.
• The current balance of this reserve is zero. In 2018 it had a balance of $1,250,000 which was depleted in 2019.
• There is a $2 million fund limit with a maximum annual contribution of $250,000.
• All requested funds to contribute will be municipal funds as provincial funds cannot be contributed to reserves.

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health approve contributing $250,000 to the Technology & Infrastructure Reserve.
Carried

Mr. Steele introduced the third report, Report No. 20-22FFC, re: Proposed 2023 Budget, and invited Ms. Williams to provide an overview. Ms. Williams shared a PowerPoint presentation.

Highlights of this report included:

• Mitigation funding to offset the proposed changes to cost-sharing between the province and municipalities and COVID-19 extraordinary funding have been confirmed by the province; however, 2023 base funding information will not be available until early 2023.
• Funding assumptions include that provincial funding levels will remain flat to 2022 levels and that requesting additional funds from the municipalities will exceed the planned level of contribution.
• Inflationary pressures from salaries, step increases, and benefits and other financial pressures such as reducing gapping, total an organizational financial pressure of $1,200,000 for 2023.
• General expense reductions through zero-based budgeting process total $437,217. Largest areas of impact include program supplies, professional development, and travel and accommodations.
• Proposals on decreasing corporate expenses include reducing cell phones across the organization ($12,000) and reducing the number of summer students in the vector-borne diseases team from six to four ($22,000).
• The planned disinvestments reduce the overall target to $815,992 which will require reductions in programs and services. To identify potential reductions, two frameworks will be used: Public Health Program Pyramid and Critical Business Infrastructure.
• As information regarding provincial base funding will not be known until early 2023, it is recommended that any additional changes to the organization be paused pending this information.

Mr. Steele commented that the timing of the provincial information is a result of the Health Unit and the Provincial Government operating on different fiscal years. MLHU operates from January to December while the Province operates from April to March.

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health:

1. Approve the savings identified from the General Expense zero-based budgeting review in the amount of $437,217;
2. Approve the disinvestment in cell phones and students in the Vector Borne Disease Program; and,
3. Advise no further changes in programs and services until 2023 provincial base funding amounts are known.

Carried

It was moved by Mr. Steele, seconded by Ms. Hamou, that the Board of Health receive Report No. 67-22, re: “Finance & Facilities Committee Meeting – November 3, 2022” for information.
Carried
Walk-On Report: Laptop Purchases – Contract Award (Report No. 68-22)

This report was introduced by Ms. Williams who introduced Mr. Pat Harford, Manager, Information Technology.

Highlights of this report included:

• The Health Unit has an annual process of reviewing and refreshing information technology assets, including laptops.
• As part of this purchase process, three bids were considered. Stronghold was the least expensive bid that fulfilled all requirements.
• As this purchase is part of the financial plan, budget is already allocated for this purchase.

It was moved by Mr. Steele, seconded by Ms. DeViet, that the Board of Health:

1. Receive Report No. 68-22, re: “Laptop Purchases – Contract Award,” for information; and
2. Approve entering into a contractual agreement with Stronghold Services Corporation for the purchase of laptop computers.

Carried

Correspondence

It was moved by Ms. Cassidy, seconded by Ms. Elliott, that the Board of Health endorse item a) and receive items b) and c).
Carried 

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, December 15 at 6:00 p.m.
Carried

Confidential

At 8:16 p.m., it was moved by Ms. Hamou, seconded by Ms. Elliott, that the Board of Health will move in-camera to approve previous confidential Board of Health and Committee minutes, to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees, and labour relations or employee negotiations.
Carried

At 9:43 p.m., it was moved by Mr. Steele, seconded by Ms. Hamou, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 9:34 p.m., it was moved by Ms. DeViet, seconded by Mr. Steele, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary